It's not about a lack of funding, it's about a pervasive indifference to the patients' needs.
In the wild, when an animal is sickly, the others sometimes abandon it or kill it. The thrust is towards survival of the species rather than nursing the weakened back to dubious health.
The indifference displayed by the bulk of our nursing staff reflects this instinct. This is not confined to the overcrowded, under-resourced public sector, where nurses are stretched through 36-hour shifts and depleted of any inclination to tend to patient needs. Even in the plusher private sector, sustained by costly medical aids, the patient doesn’t come first.
The quality of nursing is marked by the same nonchalance, slightly camouflaged by a veneer of friendliness. They call you “my darling”, “my sweetie” when they diligently pack you into a bed and take your blood pressure, then forget you soon after.
I was recently admitted to a private clinic, which I would prefer not to name, for a minor operation. The woman just diagnosed with pancreatic cancer in the bed next to mine wasn’t given a meal when she was brought to the ward in the late afternoon after a day of fasting in preparation for the biopsy.
Yes, the sister in charge said she would order one, but never got round to it and when I passed on the request that evening she snapped at me and replied she knew her job.
That night, when the drip emptied and I rang the bell, she came and strung up something different. “What is it?” I inquired. She ignored me. I repeated: “I asked you a question and you didn’t answer. I’m trying to have a conversation about what’s in the drip.” “Well, you don’t have conversations when people are trying to sleep,” she snapped.
The patient newly diagnosed with pancreatic cancer witnessed the exchange. She was sitting bolt upright in the bed next to me, in pain and waiting for a dinner that never came. Some nurses giggle about the “possessiveness” of doctors, how they tend to take nurses hostage and demand their services all the time. “He makes me take my leave when he takes his,” Sister Zama says. “It’s like he owns me. Why do I have to follow him around?”
Someone should tell her that it’s understandable, because good nurses are a scarcity you dare not let go of. When you find a good nurse, you guard her jealously because she’ll reinforce your clinical reputation by keeping your patients alive with good aftercare.
When the doctor examined me after a foot operation, he came with a nurse and showed her how to change the dressing. He couldn’t know (though maybe he suspected) she was merely paying lip service to his request, listening but not attentively, not taking notes and ready to disappear the moment he left. “Keep it dry,” he recommended. “No water. No need to disinfect. Just some gauze between the toes, then wrap.”
He left the foot exposed, leaving orders for pain medication. The nurse went too and never came back. My foot was forgotten. The stitches pulled. I rang the bell and another nurse came. I told her it needed to be dressed and she acquiesced and disappeared. What was one to do? An hour passed and I rang the bell and complained. A sullen male orderly agreed to dress it. I repeated the doctor’s instructions not to wet it and he put away the sterilising solution. How was he to know?
So I survived the private hospital experience, thanks to a good support team of family and friends. And, armed with a good education and by being assertive, I was able to repeat the doctor’s instructions to nurses who didn’t hear. I was able to insist I was brought food and that my foot was dressed. Sure, I didn’t lose a baby to a contaminated drip and I wasn’t turned away because of bureaucracy.
But nursing negligence starts insidiously with the little things.The attitude of indifference that allows nurses not to change a dressing has the same genesis as the one that permits nurses to neglect rinsing babies’ bottles or check for contaminated drips.
I don’t believe a jacked-up public health system is going to solve nursing apathy and that it’s simply a case of not enough funding for state hospitals. No diverted cash flow from private to public health is going to heal nursing apathy in either sector. Challenge me on that one. Call me reactionary, but disciplinary measures—even firing the indolent and hiring a new—might bring about change.
When the pretty public relations person with tight jeans read my feedback form she laughed and handed me a corporate gift, branded with the clinic logo. In the plastic ziplock were soaps and shampoos, sample toiletries for a sojourn at the clinic.
Felicity Levine heads the Wits Journalism Development Communication Programme and this article is written in her own capacity. This article was written following her experience in a private clinic in October