Give the nurses a break – and lots more money

Health Opinions - October 20th, 2000
Robert J. Collins

by Robert J. Collins

Medical Mayhem
“A survey shows that nurses are to blame for the one patient per day who receives the wrong medication at each hospital in the Tokyo metropolitan area.”

The Japan Times, Oct. 8, 2000

The article goes on to say that 257 patients were victims of mistakes during the one-month survey conducted last February. “The most common day for mistakes was the patient’s first day in the hospital, with 26 instances recorded.” Just so you’ll know, mistakes tapered off as one week passed, then the screw-ups shot up again beginning with the second week.

Maybe it’s just me, but I’m somewhat reassured that medication mistakes were committed by nurses and not the janitorial staff or the people who come in to pick up the laundry.

“What do ya think, Watanabe, should we fill up this guy’s drip bottle with brake fluid?”

“Nah. Try this detergent. It gets out spots.”

Of course, the mistakes in the delivery of medicine are going to be primarily the fault of nurses. Who else delivers medicine in a hospital? Not the doctors. They’re too busy scratching their heads, reading files and making sure their patients are whisked around before they can ask questions. In fact, this current survey goes out of its way to exculpate doctors. “Doctors were blamed for issuing erroneous instructions in just (my emphasis) 48 of the 257 cases.” Can’t make many mistakes scratching heads and reading files.

Now then, if I had to list by category the most heroic and selfless professions on earth, nursing would be right up there along with firefighting, being Prime-Minister of England and playing baseball as a gaijin for the Kintetsu Buffaloes. It ain’t easy doing what they’re doing.

Unfortunately (or fortunately for the purposes of this column), I’ve had more than my fair share of opportunities to watch nurses in action in Tokyo city hospitals. About every six weeks or so I visit my friends at Hiroo Hospital to have fluid removed from my knee before it explodes and ruins my pants.

The ordeal is more complex than just going in for a flu shot. The event happens on a steel operating table and is preceded by a series of heart and blood pressure tests. (The pain involved with taking a needle the size of what your grandmother used when knitting, and then tapping it deep into a joint is, to put it mildly, exquisite.) The tests are to make certain that the exquisite sensation doesn’t shock the old heart into hysterics so that it gives up on the whole thing as a lost cause.

Watching the folderol surrounding the nurses as preparations are made, I’m amazed anything gets accomplished. While pills are counted or injections are prepared, patients wander in with broken bones, bleeding body parts or hacking coughs behind little white face masks. None of them seems capable of filling out the forms required for the next step in the healing process. Nurses must stop and help them.

As this is going on, doctors periodically wander through the area prepared to give shots or take blood samples. Nurses must again stop whatever they’re doing to assist the sensei. Pills remain partially counted, injections remain partially prepared and the wandering patients increase by several.

One day, as all this chaos was happening, Miss I to appeared on the scene. She is one of my all-time favorite nurses—the night person on duty when I had once stayed in the hospital after an operation on my knee. She was still a night-duty nurse, but this was 10 o’clock in the morning.

“I am staying overtime,” Miss Ito said, wiping her hands on her hips and picking up a partially prepared injection, “because of too busy in here.”

Miss Ito, who emptied bedpans, gave body baths and held hands through the night with people in pain, was downstairs helping out. She, I know, earns less than anyone in the clerical staff of my company. For all I know, she may have been one of those people making the 257 mistakes. But she is also a rare jewel in the crown of humanity.

I guess the point of all this is that the “medical mayhem” screaming at us in headlines is to some extent real, but to lay the blame on nurses as if they’re spaceheads goofing around in the healthcare business is a colossal mistake. Nurses are the foundation of the healthcare business. The system is the problem.

What can we do? Who knows? A couple times a year, the Nursing Association takes to the streets around the hospitals—in the Hiroo area, for example— soliciting signatures to assist in their efforts to beg for pay increases. Sign the petitions. Otherwise, there is little direct action anyone can take.

Except pointing out to papers such as The Japan Times how thoughtless and harmful “Medical mayhem” headlines are in the real world as it exists now in Japan.