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"I, Robot, will empty your bedpan"

October 29, 2006 -- Today the Victoria Times Colonist ran a Canadian Press piece about how advances in robots may change the practice of nursing. The unsigned piece appears to be based mainly on comments from Michael Villeneuve, a researcher with the Canadian Nursing Association. Villeneuve has been studying how technological changes may affect nursing at a time when both the profession and the patient population are aging. He makes some good points, particularly his comment that nurses must actively shape their practices or others will do it for them. Unfortunately, the piece also contains statements that tend to suggest nursing consists of hand-holding and basic custodial tasks. We wish the report could have conveyed what technology can, and cannot, do to help short-staffed nurses with the many nursing tasks that require advanced skills--like assessments conducted while emptying a bedpan.

"I, Robot, will empty your bedpan" appears to be based mainly on remarks Villeneuve recently made to the United Nurses of Alberta convention. It begins by noting that robots "might soon pass scalpels to surgeons, retrieve blood from hospital blood banks and even answer the phones at busy unit desks--all so that nurses can spend more time with patients." Villeneuve says that these types of changes are imminent, and that nurses must have a say in them, because "[i]f we aren't going to shape our practice in a different way, other people are shaping it for us." Villeneuve's team's study of the future of Canadian nursing estimates that the nation will be short at least 18,000 nurses by 2009, and it notes that last year, Canadian nurses put in enough overtime to fill 10,000 full-time jobs--the highest rate for any job group.

Villeneuve rightly suggests that these trends, in combination with urban growth and new diseases, will place a great strain on nursing, and that technology could help nurses cope. According to the piece, Villeneuve points to robotic advances in Japan as a "possible solution." There, robots are in development that can lift patients and bathe them. Villeneuve also says robots have been designed to evaluate bandage placement and (in the piece's words) "send the images back to a doctor who can operate the robots from a remote location." This seems like an odd comment, since nurses are primarily responsible for managing bandage changes. The piece notes that "[e]mbracing technology that streamlines nursing jobs will also help in recruiting young nurses, especially if it cuts down on mundane and unpleasant tasks." The piece allows that some nurses are "skeptical," quoting Edmonton's Theresa Barr as noting that the technology of recent decades has not "freed nurses for more meaningful work": "I guarantee those nurses aren't having any more time to go in and touch [a patient's] hand and say 'how are you?"

There are some fair points here, but there are also suggestions that nurses are basically low-skilled custodial workers whose ranks could be thinned with no ill effects by some basic robotic help, freeing the remaining nurses to do the hand-holding that is really their best use. Of course machines that would help nurses lift, provide basic hygiene to patients, or streamline administrative work would be a tremendous help to short-staffed nurses. And such technology might free nurses to provide more emotional support--which is what the media typically means when it refers to nurses "spend[ing] more time with patients." But such technology would be far more useful if it allowed nurses time to do the skilled assessment, critical thinking, and life-saving care tasks that many find increasingly difficult to manage. Barr's comment may be at least in part a reference to assessment--she does mention asking "how are you?"--but few readers are likely to see it as anything but hand-holding.

No doubt fewer "mundane and unpleasant tasks" could aid in recruitment. But each task must be examined carefully by those who understand nursing before it is assumed that no nurse is required. Bedpan changing and certain other hygiene tasks may sound like mundane jobs for robots. However, when nurses are not involved at all, they miss vital chances to assess the patient, including internal organ functioning and body output, possibly detecting changes that could mean the difference between life and death. Skilled bedpan emptying can lead to diagnoses of kidney, liver, and gallbladder disease, intestinal bleeding, obstructions, infections, prolapses and the cognitive impairment that can precede continent patients becoming incontinent. The public understands none of the skilled assessment that occurs when nurses "empty a bedpan." And it appears that may be equally true of the many health administrators who seem eager to replace nurses with less expensive unlicensed assistive personnel, who naturally could not begin to do such assessment. In this area, unthinking reliance on less qualified personnel or technology can mean that diagnoses get missed, and patients deteriorate, suffer, and die needlessly.

As for the surgical robot, the piece states that a New York surgeon "has developed a robotic surgical nurse he calls Penelope, Villeneuve said, who will pass him the correct surgical instrument and then record whether it's placed back on the tray, to avoid implements being left in a patient's body after surgery." Of course, we hope Villeneuve did not actually call Penelope a "nurse," since Dr. Treat's robot is in fact a machine that can count and hand people some things on voice command, rather than a highly skilled clinician with years of college-level science education. We hope that the promising Penelope can, as this piece suggests, "improve safety and ... address a growing shortage of surgical nurses." But as the Center has explained in analyzing prior press accounts, there are countless vital scrub nurse functions, including a range of critical judgments and actions, that Penelope will not be doing any time soon. For instance, press accounts from March, 2006 reported that a Bay Area OR nurse had prevented an allegedly intoxicated surgeon from operating.

So to suggest that the robot is a "nurse" and imply that it will address the nursing shortage in a significant way--as we persuaded Dr. Treat himself to stop doing in early 2005--undervalues nurses and invites decision-makers to replace them with machines that can do a small fraction of their work.

We thank the Canadian Press for its coverage of these important issues.

See the article: "'I, Robot, will empty your bedpan'" in the October 29, 2006 edition of the Canadian Press.

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