Tuesday, May 30, 2023

Lay off the nurses, they deserve better

As we gaze into a future of telemedicine, AI-aided diagnoses, remote analysis of X-Rays, and sending our screening tests and samples by courier, it’s possible to see how doctoring could be re-positioned to do a lot more in the future with the same resources.

Doctors don’t particularly welcome that prospect, of course – no-one likes change. Especially when that change is driven by cost-savings, rather than patient benefit. But the profession will move – will have to move – based on limited resources and ever-increasing demands.

The reality is that technology will allow doctors to change the way they go about their business, and that is a good thing. If, and of course, this is a big ‘if’, we don’t get too excited about the technology and remove the human element.

Because a key part of being a doctor is to give that one-to-one assurance that only an in-person consultation can give.

“Am I going to live?” That’s not a question that can be answered remotely. Personally, I want to look someone in the eye when I ask them that question. I want them in the same room and with as much time as I need. And this is true for many lesser questions, which are still very important to me – or any patient.

It’s the same with nurses. When you’re sick, you have needs. Yes, you need all the medicine and technical gizmos to come to your aid, but you also need another human being there to help you get through the ordeal of being unwell. A robot just won’t do.

Nursing requires patience, skill, knowledge, kindness and courage. Take a guess at how many nurses and midwives were assaulted between January 2021 and October 2022? There are roughly 66,000 nurses in patient-facing roles in Ireland, if that helps. We’ll come back to this later.

But the fact that we need to discuss assaults on nurses is, in itself, an indication of how thinly they are stretched. It’s also a big disincentive to young people who might want to join their ranks. No-one in any other profession would be expected to endure an assault during the course of their work. But with nurses, the reaction is ‘meh’.

As usual, we are not going to solve this problem because of any sympathy for the nurses’ plight, or because it’s the right thing to do – instead we are only going to really address this problem when it becomes a problem for patients.

And there are two major problem areas in nursing right now, neither of which look like being solved completely or effectively without a major change in direction.

The first is staffing levels. Today – the international day for midwives – we have 1,425 midwives employed by the HSE. This figure is down on the 2020 figure of 1,486. Which is incredible – given the increase in population. It also makes the idea of a fully-realised community midwifery service – which is something that women want – impossible to implement.

The second is the cost of housing in our big urban centres where most of our nurses are employed. This is a ticking time bomb because young people coming into the nursing profession simply cannot afford housing near to their place of work. The burdens of reversing climate change (well, ameliorating it, at least) means that it won’t be possible to drive long distances to work in the future. What are nurses to do?

The answer is to emigrate. 14,000 qualified nurses have left the Irish health system since 2010, and that figure is rising every year. And a Department of Health report in 2021 showed that 43% of nurses working in Ireland graduated abroad.

So, in effect, we are educating nurses for Australia, the UK and the US, while we import nurses from the poorer countries who cannot afford to keep them. This is precisely what we’re not supposed to do.

This is the kind of colonialism that keeps Africa and other under-developed nations from achieving their full potential.

There has to be some form of support for nurses to live – not merely exist – in our larger cities and towns. Yes, such a move would have the potential to ultimately be applied to teachers, Guards or even civil servants (“After all, the Nation is in our care” – Sir Humphrey) and cost a truckload of money, but the alternative is to have so few nurses that patients are unattended. The alternative is simply to have patients piling up in corridors and wards. The alternative is to thank God you have private insurance and a private hospital bed and hope no-one notices that all the nurses have gone from the public hospitals.

In fairness to the Minister, the Department and the HSE, another 854 nurses are to be recruited this year to ‘fully implement the Framework for Safe Nurse Staffing and Skillmix in all acute hospitals nationally’, but this is merely the tip of a looming iceberg.

The reality is that we need thousands of more nurses and we’re not going to get them at current pay rates, given the cost of housing in our major urban centres.

What to do?

We could directly help nurses by providing accommodation at discounted rates. Many nurses spend years in rich countries in the Gulf saving for a house. It would be impossible to pay Gulf rates to nurses – and subsequently to the teachers etc. – but we could provide them with cheap on-site accommodation to allow them to save for their house here.

But that’s merely tinkering with the problem. The real solution is to decentralise a lot of jobs out of Dublin (in particular) in other sectors and create the space (and prices) in the housing market that essential workers like nurses need.

But that’s unlikely to happen. Take the new Children’s Hospital, for example. Look where they built it.

If it had been out on the M50, it would have allowed staff to live in Kildare, Naas, Newbridge – perhaps even Drogheda.

But putting it in central Dublin means that the nurses who serve it will also have to live in Dublin. And they can’t afford that. We’ll just have to staff it with nurses from abroad who will put up with poor living conditions because perhaps they will eventually have a better life here than at home. Or maybe they’ll put up with it because the money they make here will fund life at home.

We really should do better than this. Not just for the nurses – who deserve better, obviously. We should do better than this because nurses are such a key part of the health service – vital, in fact – and we’re going to need lots more of them in the future.

Six thousand. That’s the number of assaulted nurses in that short period I mentioned earlier. It’s roughly nine nurses every single day. It’s unsustainable. It’s unacceptable.

So when someone says that nurses will cause anguish by going on strike, when some media head on a TV chat show looking for Twitter likes claims ‘nurses have cushy jobs’, when the Minister says he is ‘investing’ in nurses, think about the nine nurses assaulted that day. It doesn’t matter which day, because that’s every day. Think of the 94 per cent of nurses who say their work is impacting negatively on their psychological well-being, the almost 10,000 people who languished on trolleys last year, or even the innumerable people who have died in our hospitals in the last few years because of gross over-crowding.

And lay off the nurses. They deserve better than this.

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