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The silent servers of healthcare

26 May 2021

  • In the month of International Nurses Day, we must ask ourselves if we give our nurses the value they deserve

By Dr. Dilshan Anthony Fernando   As we battle a raging pandemic, we are constantly reminded of the importance of healthcare workers. Their commitment in caring for the sick and battling it out in the frontlines, enduring many obstacles and hardships, has definitely been commendable. Among these healthcare workers, an important role is played by nursing officers, a group of professionals whose importance and autonomy is gradually increasing, and rightly so. They have been manning the frontlines shoulder to shoulder with doctors in caring for patients day in and day out, putting their lives on the line. As professionals who live through the day with patients, a nursing officer’s role is of utmost importance in healthcare delivery. They administer drugs, monitor vitals, co-ordinate relevant investigations, measure urine output, and sanitise and clean patients, as it is their responsibility to implement the decisions made by doctors. However, there are many senior nurses who come up with their own valuable suggestions in managing patients as well. As we celebrated International Nurses Day earlier this month, it is pertinent to recognise and appreciate the service rendered by nurses during this pandemic and since the inception of the nursing profession.   History of nursing  Nursing has been prevalent from prehistoric times in a rudimentary form, i.e. in terms of caring for the sick, feeding them, cleaning wounds, and nursing them back to health. During wars, epidemics such as cholera and smallpox, and pandemics such as the Spanish flu and the Black Plague, nursing victims back to health was done by men and women alike who were the forerunners of the current nursing profession. Catholic nuns were also involved in nursing the sick before the inception of the modern nursing profession, as their practice of charity involved caring for the sick. Even though nursing was tagged as a profession for women in the traditional context, since the early stages, males have also played an important role throughout history up to date. “During epidemics such as cholera, typhus, and smallpox, men took on active nursing roles. For example, Stephen Girard, a wealthy French-born banker, won the hearts of citizens of his adopted city of Philadelphia for his courageous and compassionate nursing of the victims of the 1793 yellow fever epidemic,” according to “Medicine and Healers Through History", edited by Kara Rogers. However, the nursing profession was revolutionised and adapted to a more scientific form of practice due to Florence Nightingale. During the time of Florence Nightingale, tending to the needs of patients and caring for the sick were looked down upon and thought to be beneath women of class. However, Nightingale changed that perception and social conventions about nursing by using scientific principles and education on the management of the sick, which resulted in drastic improvements. During the Crimean war in 1854, the British learned that the Russian soldiers who were injured and cared for by Russian religious orders appeared to fare much better than British soldiers. Thus, Florence Nightingale and a team of nurses were deployed to Scutari to care for wounded soldiers. They made calculated and scientific changes, ensured adequate nutrition, and maintained sanitary conditions and ventilation, which promoted healing and better outcomes.   The modern-day role of nurses According to the International Council of Nurses (ICN), the scope of nursing practice “encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings”. Currently in Sri Lanka, each branch of healthcare has trained nursing officers executing care of the sick, health education, infection control, midwifery, assisting in surgical procedures, and engaging in all aspects of healthcare. Private sector hospitals maintain their own nursing schools which train nursing officers to be employed by those respective hospitals.   Personal experience As a medical student, my first procedures were taught to me by nursing officers rather than medical officers. Of course, the principles were learnt in a lecture hall, but executing it in wards was a whole different scenario. Inserting cannulas, starting IV (intravenous) drips, and dressing wounds were all taught by nursing officers. Then, after graduation, as I stepped into a government hospital as an intern house officer, I was very apprehensive – the weight of being responsible for patients in an entire ward was weighing me down. To make things worse, we had a gruelling schedule which required us to be at the ward by 6 a.m. and work continuously till 10 p.m., and since there were only two medical officers per ward at my intern station, we had to be on call every other day. This meant that I had to be in the ward 40 to 50 hours at a stretch sometimes. This schedule, along with supervising consultants who expected nothing but perfection, meant that we had to perform our duties meticulously without margin for error, which was a near-impossible task. These tasks were made easier by senior nursing officers who treated us like their own children, sometimes helping us with our work and informing us of tasks we overlooked. In working these gruelling hours, inadvertently we missed our meals and didn’t have time to go looking for food; since this is a regular occurrence, most nursing officers ensure that they bring food for the interning medical officers in the ward and force us to stop working for a moment to eat something before we battled on in caring for patients. Therefore, almost all medical officers are nurtured and cared for by nursing officers during internship, which is the toughest period in one’s medical career. Personally, another nervous experience for me was manning the labour room, where the lives of mothers and newborns are in our hands. Monitoring mothers in labour, managing their pain, and ensuring delivery of a healthy baby are of utmost importance. There is zero margin for error, and potential for sudden mishaps like bleeding, vaginal tears, and foetal distress during labour are common occurrences. In the months I spent in the labour room, I learnt as much from nursing officers as I did from my supervising consultant. The nursing officer in charge of the labour room was a commanding character whose intuition for impending disaster was something no one ignored. She could foresee complications that most doctors also missed. Whenever she would request for extra precautions to avert a disaster, we never ignored those requests because almost always those situations turned out exactly she foresaw it. When suturing episiotomies, giving epidural pain relief, the resuscitation of distressed newborns, or rushing mothers in distress to the theatre, the nursing officers have been by our side. As a fully registered medical officer/senior house officer in charge of a paediatric ward, the support I received from our nursing team was unbelievable. Paediatric nursing is an entirely different practice from that of other wards, as caring for small kids and babies requires special skills and training. Similarly, in each unit, nursing officers have been competent and efficient in different specialties and an integral part of healthcare delivery.   Government-trained nurses vs. private sector nurses The popular notion is that government-trained nursing officers are superior in skills and attitudes than nursing officers in the private sector. Having worked in both government and private sector hospitals, I have experienced the best and worst of both worlds. Undoubtedly, the government-trained nurses have an edge over the private sector, but I have also seen extremely skilled, knowledgeable, and efficient nursing officers in the private sector as well. However, the private sector has a big gap to bridge in developing nursing officers to the required standards.   Role of the Government Undoubtedly, nursing officers are a group of professionals who are undervalued in their service rendered to the sick. Their value has never been felt as much as it is now, when Sri Lankan healthcare workers are on the verge of burnout due to massive numbers of Covid-19 patients. Several nursing officers have paid the ultimate price and succumbed to Covid-19 in their care of these patients. I believe it’s time to give credit and design a structured programme for their continued development and training to better serve the public of Sri Lanka. Furthermore, the Government should structure a scheme of remuneration in appreciating these silent servers of healthcare.   (The writer is a medical officer currently attached to a government hospital. His experience spans across the medical profession as a medical practitioner, and across the pharmaceutical and surgical equipment industry. He also possesses an MBA and a Diploma in Economics. Having represented his university rugby team in international tournaments, he also has a special interest in sports medicine)


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