Registered Nurses are the backbone of the hospital

This testimony is based on my doctoral research about Registered Nurses and their work in acute care. Observations and interviews were conducted to understand their work. (The term nurse was used throughout the dissertation in reference to the Registered Nurse). From the acknowledgements: This dissertation is dedicated to all nurses working in hospitals. You are the backbone of the hospital. Thank you especially to the nurses who shared their work day with me. Besides your willingness to answer my many questions while we were on our breaks, your compassion for your patients and respect for the profession of nursing will always be remembered in my heart. Your patience, caring, and knowing ways were evident as I spent my time with you. I know that one day, one of you will look after me, my family, and friends.

Every day and every night, Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs) use their nursing knowledge as well as physical and emotional skills to care for patients in hospitals and communities, work which is often taken for granted. During my observations, at numerous times throughout their shifts, I noticed nurses working as a team to make important assessments and update each other on the progress of the work, what needed to be done and who would do what next. Much of this unseen work required ongoing communication and coordination of time and resources by the team. For example, if one member of the team required assistance with a patient he or she negotiated how this work would be done. Nurses were often seen assessing, consoling, educating, bathing, lifting, feeding and organizing their patients’ needs. Within hospitals, nurses often work in teams and are productive because they have learned to organize themselves to be efficient in managing the pace of their work. Because of the hospital’s overcapacity issues, nurses are often required to care for additional patients. Nurses repeatedly expressed concerns for patients’ privacy and their care in makeshift rooms, yet they were able to make adjustments to accommodate these overcapacity patients.

Nurses provide their services 24 hours a day, 7 days a week, while many other services in the hospital are available primarily on weekdays, during the day. The business of the hospital requires the flow of admitting and discharging patients, however, overcapacity and overcrowding have become common within hospitals today. Since discharge is a priority, RNs would provide information to the discharge team about what they knew about the patients, answer questions from the group and then leave the meeting (which was often scheduled in the middle of their work day) and return to their other patients. Since nurses are the closest personnel to the patient, they are often asked by pharmacists, social workers, physicians, dieticians and physiotherapists to provide information about the patient’s progress related to the discharge plan. Because they work closest with the patients, they have knowledge about the patient’s mobility, breathing, pain, blood work, intake and output. Nurses also provide ongoing information to the patient and give messages to the family. Nurses have the knowledge and skills to assist in meeting the patient’s targeted discharge date. If the patient requires increased mobility, more fluids, or oxygen weaning, nurses work with the patient to plan accordingly. They also assist in arranging future appointments with physicians and other services, provide patient education, complete the required computer and paper work, and call other services if further information is needed. They will often wait for families or friends to pick up the patient while they assist in packing up their belongings, locating a wheelchair and then accompanying patients. Nurses can also be seen saying good-bye, giving hugs and offering reassurances to their patients. Nurses are integral in facilitating patients through the system.

Throughout their shift, nurses constantly check on their work and the work of others to ensure patient safety. Research shows that RNs improve patient outcomes and are a sound investment for hospitals (Dall, Chen, Seifert, Maddox, & Hogan, 2009). Lean strategies such as RTC have improved system processes, however, nurses must still manage increasingly acute patients, overcapacity patients and the push to discharge. Given the systemic problems in contemporary hospitals, nurses do their best every day and every night to provide quality, safe care. Hospitals, governments, professional organizations, unions and nurses aspire to the same goal. Thus, new knowledge must create awareness about the value and influence of nurses.

Ann-Marie Urban, RN, PhD -- Assistant Professor, Faculty of Nursing, University of Regina