Outside of attending NMC meetings, writing this blog and having my fingers in other proverbial pies, I still have time to work full time as registered nurse in an acute hospital. My day to day practice consists of two parts, I have a permanent role as a scrub practitioner at the trust, but I also enjoy maintaining my skills in ward and specialist based practice through a staff bank (given most nurses current situation, I dare say not many don't!). Nonetheless, it is important to me to widen my professional horizons as well as pick up a few extra pounds.
This particular issue arose out of my practice in the operating theatre. The trust I work for have recently reviewed the swab, sharps and instruments policy. Any nurse practicing in the peri-operative environment will be fully aware of such a policy and every hospital trust that carries out invasive surgical and/or diagnostic procedures will have such a policy in place. For those of you who don't work in such an area, it is essentially the policy that stipulates responsibility for swab, sharps and instruments checks and counts during a procedure and responsibilities (among other more specific duties) of each profession in order to facilitate safe surgery.
Due to some issues with clarity in areas of responsibility the trust took the liberty of reviewing the policy and thankfully decided to be highly specific about who takes responsibility for what and when. This is where the issue of multidisciplinary equality began. As part of our checks that are undertaken as a "team", we religiously perform the stages in a WHO surgical safety checklist...without fail I might add. All of the above is necessary to ensure we get everything right the first time, when getting it right is of high importance.
As a team we share the responsibility of performing the necessary checks and supporting each other to fulfil our duties. One benefit of working in such an environment is based upon trust and spending a large quantity of time in one room together. However, the revised version of said policy states that it is the responsibility of a surgeon and anaesthetist to ensure that the WHO surgical safety checklist is completed and documented appropriately. One anaesthetist pointed out two interesting points, one; ensuring this new responsibility is communicated to them and secondly and just as importantly, that does this newly delegated responsibility undermine the "team" approach in carrying out this work and reinforce the concept of a hierarchy in the health care professions?
I remember in my first year of nursing school, undertaking a module in multi-professional team working, whereby students of each discipline worked together to solve a problem in patient care and role play solving this problem as a team. The aim of the module is partly to ensure each profession contributes equally and is left feeling empowered in patient care. I was in some respects, in for a rude awakening when I qualified however. In many situations on the ward, nurses can be made to feel insignificant, that doctors/surgeons make the final decision and there is no room for debate. Sadly on more than one occasion I have felt belittled by the fact my reasons for doing something were not considered as important. I have worked bank shifts on wards where the communication between the professions is poor and in some cases some professions do not believe it necessary to communicate with other professions despite it causing friction. Not to mention the lack of understanding of role or knowledge base. I believe this has a huge impact on respect for each other. This is not when multi-professional comes into its own, and why operating theatre work does encompasses everything that multi-professional work is supposed to.
Lets face it, we don't work as hard as we do for our health? I'm sure we would all love an environment where we all communicate properly and that patients are then right back where they should be. In the centre of the care! I would encourage anyone to challenge the hierarchy in multi-disciplinary working otherwise we will always be left with professions feeling demoralised, undervalued and disrespected much to the contrary of what we should be working towards. I can certainly tell you that I resent having other professions talk to me or treat me without respect as a person let alone as a nurse.
I hope to be senior nurse one day and multi-professional team working is a passion that I will promote enthusiastically, I cannot tolerate the hierarchy when it goes against everything I have learnt from tutors, professional colleagues and other nurses. I have a great deal more respect for professions that don't work on a culture of fear but instead makes other people feel respected and valued and that their contributions are equally important. one fantastic example of this is the comments from Dan Poulter in this week's Nursing Standard. I commend his thought into the role of nurses, not necessarily his full opinion. There is a doctor who understands professional empowerment.
If nothing else, it is nice to see changes. Comparing stories that colleagues describe, we have made changes in the right direction in equal working. There is still work to be done but, it is a step in the right direction. It is just disheartening when you read new policies that don't reflect the hard work of all professions. Perhaps, it is the hospital trusts that need a lesson in multi-professional team working and not the health care professionals?
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