Sadly, the critical role that nurses and midwives play in keeping people (and the health system) safe is all too often unseen and unrecognised. Maybe it is that we are so familiar and numerous that our role is somewhat taken for granted.
Everyone seems to have a close family member or friend who is a nurse, and this personal connection can be both a blessing and a curse. We are known, respected and even loved, but our work is not fully understood or appreciated.
Our 24/7 presence in the health system means that we are the common thread, the “glue” that keeps the system both safe and human. As such on a daily basis, we play a critical surveillance role.
Sometimes we are reminded of this, like the recent intervention by a nurse after two elderly residents were injected with a higher than the recommended dose of the Pfizer Covid-19 vaccine at a nursing home in Carseldine in the north of Brisbane. As soon as this error was detected, the nurse immediately spoke out and then stayed to monitor the residents following the departure of the doctor who had made the error.
Unfortunately, this doctor had not undertaken the mandatory vaccination training course provided through the Australian College of Nursing. (I hope this case does not point to a wider reluctance on the part of medical practitioners to complete this training because it is being provided through the Australian College of Nursing.)
Federal Health Minister Greg Hunt immediately called an urgent investigation. The CEO of Healthcare Australia, the private company contracted by the federal government to undertake the Queensland aged care facility vaccination program, has been stood aside. The Federal Government immediately sent in a nurse – Debra Thoms, a former Commonwealth Chief Nursing and Midwifery Officer – to sort out the issue. Of course they did. This all has a long way to play out yet.
It is another example of the problems of outsourcing in health – from quarantine to aged care.
Thankfully, the 88-year-old man and the 94-year-old woman do not appear to have experienced any adverse reaction, though it was reported that scheduled surgery for the man has been delayed.
This error highlights a number of critical issues for the ongoing rollout of the Covid-19 vaccine program.
Most importantly, we must establish processes to ensure that the mandatory training for health practitioners has been completed before they start vaccinations. This is especially important given the federal government vaccine rollout is occurring via sub-contracting arrangements that make robust oversight more difficult.
Ensuring that the mandatory training is completed by all is essential as errors could be more likely to occur given single-dose vaccines are more commonplace and the Pfizer vaccine comes in a multi-dose vial.
Establishing robust planning, governance and reporting arrangements for the vaccine rollout is vital given its scale and complexity. The federal and state governments must be clear about their respective roles and who is best placed to effectively conduct the vaccinations on the ground. Providing adequate funding for this is essential, especially given the competing demands being experienced by our public health system.
But for me this case also highlights something more fundamental. The vital role that nurses and midwives play in keeping patients and residents safe is too often taken for granted. The entrenched power imbalances in our health system reinforce this under-valuing.
For me, our nursing and midwifery values of caring, advocacy, holism and professionalism sum up the richness and nuance of our work and contribution.
Caring is central to our role, and too often the caring work we do is not seen or adequately valued. The pandemic has highlighted that “caring work”, done by nurses, midwives or others, is central to both our health and economic recovery. Caring is foundational to a well-functioning, cohesive and fair society and economy. Hopefully, the pandemic will assist in re-framing our public debate to acknowledge this.
We advocate for those in our care instinctively every day, at an individual and system level. Nurses and midwives coordinate, interpret and help navigate care. Just like the nurse in this example, we have the courage to speak out when mistakes are made, or a situation is unsafe.
We look after the whole person across a wide range of settings. Nurses and midwives perform a privileged role, providing holistic care to people at their most vulnerable. Inherent in this vulnerability is the need to maintain confidentiality and dignity, so much of our work remains unspoken.
Lastly, we are professionals who are accountable to our community through a robust regulatory framework, practice standards and codes of ethics. Nurses and midwives are committed to advancing safety and quality as autonomous and accountable health professionals in our own right. Unfortunately, this is still not fully appreciated and is sometimes actively undermined by some.
Although it may not have been fully appreciated in the moment of “speaking out”, the nurse at the Carseldine nursing home gave powerful effect to these four values through her action. She is keeping our health system safe and human, and I am thankful that this occurs on a daily basis. We just usually don’t get to hear about it.
Beth Mohle is the Secretary of the Queensland Nurses and Midwives’ Union (QNMU).
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