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A time to dance, a time to mourn

June 28, 2006 -- The Belfast Telegraph has recently run good articles highlighting positive and negative aspects of nursing in Northern Ireland today. On May 25, the Telegraph published Nigel Gould's "Half our nurses quit in the last 10 years; Health chiefs alarmed as 10,000 left their jobs." Gould's piece reports that shockingly high numbers of nurses have recently left the National Health Service in the province, despite record numbers of new recruits from overseas. The piece links the exodus to poor working conditions, especially short staffing. On the other hand, today the paper published Jane Bell's "I'm not a 'male nurse' - I'm a nurse and proud of it," which tells the story of pioneering "alcohol liaison nurse" Gary Doherty. Doherty won the Royal College of Nursing's (RCN) Northern Ireland Nurse of the Year Award for his work handling endemic alcohol-related problems at a north Belfast hospital. Bell's piece shows how critical the work of Doherty's team is not only in improving patient outcomes and cutting costs, but in reducing alcohol-fueled attacks against nurses. The piece uses Doherty's gender as a hook, but it generally keeps the focus on his work. We thank the Telegraph, which has also covered the RCN award in past years, though not at anywhere near the length of this piece.

Gould's May 25 piece reports that some 9,532 nurses have left the public sector health service in Ulster since 1995--"around half the nursing workforce." The figure includes those moving to the private sector. Member of Parliament Iris Robinson links what the piece calls "huge shortages" of nurses to "dissatisfaction and disillusionment," including "[d]ifficult working conditions and recent attacks on health staff." Robinson also says that the province is "hugely reliant on nurses from overseas." Gould notes that nursing leaders argued last year that the shortage meant "patients here were not getting the best level of care possible." Indeed, the piece also quotes the Royal College of Nursing's "CN Northern Ireland Director" Mary Hinds as saying that the shortages not only "demoralised" nurses, but also meant a tragic loss of skill:

A major concern that we have about the high number of nurses leaving before retirement age is the experience that we are losing with these nurses. It might take three years to train a nurse but it takes a lot longer for a nurse to become a specialist in a particular area.

Hinds also points directly at short-staffing, noting that recently

senior nurses revealed that they are concerned about staffing levels in the workplace with nearly 60% believing that there are not enough nurses on duty to provide a good level of patient care. Nurses join the profession because they want to care for people. No wonder so many leave when they realise that they will not be given enough time to provide the care they feel that patients deserve. Solving nursing shortages in the long-term is not just about increasing the numbers entering nursing... [R]etention of nurses remains one of the biggest challenges facing the system.

These quotes suggest that nurses have valuable skills (though the piece could have been stronger on this point), and that to significant extent, the crisis may considered a "willing nurse" shortage.

Bell's longer June 28 article on alcohol liaison nurse Gary Doherty proclaims that "[f]or the first time" the RCN's "prestigious" Northern Ireland Nurse of the Year "is a bloke." But it also says that Doherty "insists gender isn't an issue in nursing." It quotes Doherty:

I'm not a 'male nurse' - I'm a nurse and proud of it. We're not 'handmaidens' any more. We are professionals, taking a lot more initiative and even more responsibility on board and constantly developing ourselves.

That sounds good, except for the implication that nurses were handmaidens in the past, perhaps the not too distant past. It's also not the case that gender "isn't an issue" in a profession that remains over 90% female, but perhaps readers will simply take this to mean that it should not be one.

The great majority of the piece describes Doherty's pioneering work at Mater Hospital, and that part is very good indeed. It notes that Doherty offers "a lifeline to the drunk and the desperate in one of the most deprived areas of the province." The piece explains that alcohol abuse is a "huge drain" on the NHS, with one study finding that patients with alcohol-related problems occupied 40% of medical beds. Doherty was the "first designated alcohol liaison nurse" in Northern Ireland. He suggests that the service started in north Belfast because "there are close links between social deprivation and alcohol and drug abuse." The piece reports that Doherty had to "fight for [his] funding" from the NHS. It cites some of the hospital statistics he used to do so, including the thousands of bed days consumed by patients with alcohol-related illnesses and over 100 new "drink-fuelled" emergency room visits--each month. It notes that in one year, Doherty's service "saved a total of 1,009 bed days in the hospital, with an estimated cost saving of over £234,000." The piece explains that although Doherty can "quote these figures off the top of his head," he is more concerned with the "human cost" of alcohol abuse, which affects everyone around the drinker.

To its credit, the piece points out that part of that "human cost" is to NHS staff, because there is a "link between drink abuse and attacks on NHS staff, particularly in the frontline of Casualty." The piece reports that RCN data show that 27% of Northern Ireland's 20,000 nurses reported being attacked while on duty last year. Injuries included broken bones. In addition, 68% of the nurses reported verbal abuse. Although alcohol is of course not the only factor in violence against nurses, the piece reports that one senior casualty nurse responded to her boss's question about how the hospital's alcohol liaison service was doing as follows: "Well, I haven't been hit for a year."

The piece discusses the dimensions of alcohol abuse in Northern Ireland, and what the alcohol liaison service does to address it. The service identifies patients with alcohol problems, and Doherty then gives patients and families advice and education. The multidisciplinary team also educates and supports hospital staff in dealing with such patients. Doherty reportedly works with affected surgical patients to reduce cancellations and complications associated with alcohol. At the same time, Doherty can be paged to Casualty to help care for patients with alcohol issues. The piece reports that he negotiates the challenges of dealing with such patients "with empathy and skill," trying to push lifestyle changes that can reduce patients' visits to the Accident and Emergency department and help them manage better overall. The piece describes one "happy ending" in which Doherty "walked past one former 'regular' in the street one day and the man shouted after him, delighted not to have been recognised, so changed was he for the better."

Doherty is gracious about winning the RCN award, and in praising the work of the other contenders, he makes valuable points about nursing:

I was over the moon! It was a great honour to be recognised by my peers in the RCN - and against such stiff competition. There were a lot of great projects among the finalists. Nurses are constantly developing roles which are beneficial to patients' health. ... Nursing is a job that develops throughout life. I've always enjoyed it and wouldn't change it for anything.

We thank the Belfast Telegraph for its coverage of these important issues.

 

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