The bedpan ceiling

Scholar Linda Shields explains nursing on ABC

February 17, 2014 — Today Rebecca McLaren published a remarkable article about public understanding of nursing on the website of the Australian Broadcasting Corporation’s Capricornia radio station in Central Queensland. “The bedpan ceiling” seems to be based entirely on input from James Cook University nursing professor Linda Shields (right); the long piece is mostly a series of quotes from her. Shields says that nursing may seem simple to the public, but in fact it is complicated, challenging, and important. She notes that the profession involves decision-making about subtle changes in patient conditions, increasingly complex technology and drug and treatment regimens, and much sicker patient populations than it did years ago, when hospital stays were far longer. Therefore, Shields argues strongly that nursing requires extensive university science education and that calls to return the profession to the days of hospital-based training must be resisted. She assures readers that those were not in fact “good old days,” offering scary anecdotes about overcrowding and fatally poor care. Shields also decries the current trend toward reliance on cheaper but low-skilled health care assistants who do not report to nurses and who cannot do the life-saving work nurses do. And she concludes with a brief discussion of nursing stereotypes, including the physician handmaiden and the naughty nurse. Shields focuses on gender stereotyping, arguing that it’s vital to attract more men to the profession. We thank Professor Shields and all those responsible for this helpful article.

Language is often really powerful

The piece’s identifier for Shields is worth quoting in full:

Linda Shields, MD, PhD, FACN Professor of Nursing at the Tropical Health Research Unit for Nursing and Midwifery Practice, James Cook University and Townsville Health Service District.

This alone sends a great message about a nursing leader’s professional qualifications, indicating her academic authority, advanced degrees, and tropical health focus. Some might take Shields to be a physician in light of the “MD.” However, in Australia, the MD evidently refers to an advanced health research degree, not the entry degree for physicians, as in the United States. We note that in 2012 Shields was inducted into the International Nurse Researcher Hall of Fame.

The piece’s subhead is “Time to rethink public perceptions of nursing,” and McLaren begins with the common image of nursing as “a young, probably sexy, female mopping brows and cleaning bedpans.” “Professor of Nursing Linda Shields” argues, however, that that must change, and Shields argues that the apparent simplicity of some nursing tasks masks real complexity:

The general public don’t understand that when a nurse, be it RN or enrolled nurse or an assistant in nursing, does something like put a patient on a pan, they’re not just putting a patient on a pan. They’re using all their clinical skills to assess that person while that person’s getting on that pan and getting off: they’re looking at their skin, they’re looking at how they move, they’re talking with them to find out how things are going with their family. There’s a whole range of assessment going on while that activity is being done, being put on a pan, being bathed and showered, helping to move around the room.

Nurse on a long wardShields mentions calls in the U.K. to go back to “the ‘good old days’ when nurses trained in hospital,” but she argues strongly that they were “not the good old days.” She describes the overcrowded conditions of large Brisbane hospitals like the one at which she trained in the 1960s, where nurses were actually not allowed to speak to the patients. Shields recalls a time when she and another “student nurse” were expected to care for “70 old ladies.” One night, eight of them died, “probably of preventable causes.” Today, she says, university education is required because health services are far more complicated, with “mind-blowing” drugs and treatments. In addition, patients are much sicker on the whole because hospital stays are so much shorter, often just a day rather than a week or more. Shields stresses that nurses need university degrees (Australian RNs must have bachelors of nursing) because they must learn anatomy, physiology, biochemistry, pathology, the theory of nursing, law, and ethics. So, she explains, it’s far more than comfort and hygiene. These are all great points, and we might quibble only with the term “student nurse”; as the piece itself suggests, nursing students are not yet nurses.

Shields notes that nursing requires significant funding because nurses make up the largest proportion of the health workforce, and government ministers have worked to reduce those costs by employing other staff. However, she says, the “healthcare assistants” some wish to use “are unqualified health care workers who come in with no education and are being put into the wards,” especially in elder care. These assistants may help with bedpans and cleaning, but Shields describes a “lack of understanding about how that care is given.” And she objects that the assistants are not answerable to the RNs who are responsible for clinical care, but to “corporate services or operational services.” Shields suggests that if non-RNs must provide care in the current fiscal environment, “assistants in nursing” who have some nursing training and report to the “RN in charge” might be an answer, rather than corporate assistants who “don’t understand the clinical aspects of care.” We might add that these assistants would not be able to make the skilled assessments Shields describes RNs making earlier in this article. And the replacement of RNs with less skilled assistive personnel might not be cost-effective when health complications are factored in, as some research has suggested. There is no better illustration of the potential harm caused by decision-makers’ lack of understanding about what nurses really do.

putting patient on bedpanThe piece closes with a few notes on that very point. Shields suggests that nursing has long been misunderstood as being about “mopping brows and holding hands and putting on bed pans.” Nurses are often “portrayed as the doctor’s handmaiden, or they’re portrayed as some sexy nurse.” One key stereotype is that nursing is female, but Shields argues that the profession needs “lots” more men. She observes that language is “often really powerful,” and zeroes in on the term “male nurse,” which sets men in nursing apart, as if they were odd. She notes that only about 10% of Australian nurses are men, but some nations do not have the same stigmas, pointing to Indonesia, where the figure is apparently 25% (although we are not aware of many nations where the figure is much above 10% or any where it approaches 50%). Shields says it’s “vitally important that we get men into nursing” because they bring a different perspective and, for instance, are “fabulous to work with children, fabulous to work with women giving birth.”

On the whole, this piece has many great observations about the gap between nursing’s image and how the profession really is. However it came about, we thank all who are responsible.
See the article “The bedpan ceiling: Time to rethink public perceptions of nursing” by Rebecca McLaren, published February 17, 201,4 on the website of the Australian Broadcasting Corporation’s Capricornia radio station in Central Queensland. If the above link does not work, you can see it archived in pdf format.

 

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