Nellie's reward

Last week Dr Grumble was within metres of the great Lord Darzi. The real ermined man, not his robotic look-alike. Dr Grumble heard him speak and for the first time Grumble thought that the noble lord might just be on our side. But Lord Darzi is a consummate politician. He knew his audience was full of doctors and he knew just how to woo them with his soft Irish brogue. One of the things he went on about was quality. He pointed out that doctors want quality. He pointed out that doctors like competing with each other on quality and that this was ingrained into us. It is true.

Essentially Lord Darzi said that we like to do a good job. He is right. We do. And so do nurses. We don't need special bonuses to do the best job we can. Nor do nurses. Doctors are very good at doing the best job they can within limited resources. So are nurses.

In medicine you rarely have everything you need instantly. The diagnosis would be nice but cases are more often grey than black and white. There is always a differential diagnosis.  Patients and relatives do not like uncertainty. Nor do doctors. Uncertainty needs to be managed. But we learn to work in our imperfect world. Amongst the imperfections are resource limitations. Even our friends across the pond recognise the problems involved in getting sophisticated investigations out of the radiology department late on a Friday. 



Perhaps it is our collective readiness to paper over the cracks in our service, some of which are inevitable, which has led to our unwillingness to raise the roof when things really go wrong. But some of what we see in the way of limited resources is endemic, planned even. It is a systematic collusion with inadequacy. Why, for example, can more and more work be piled onto nurses apparently without limit? Below is what Nurse Anne has to say on the topic:

It was chaos. Thank god Nellie came in. A childminder may be able to set a limit on the number of people she looks after but a nurse cannot. A childminder cannot have additional children dumped on her with no warning, on top of her other charges. But we do this to nurses and expect them to function every day. Otherwise, they would have to close much needed beds.

Dr Grumble has witnessed some of this sort of thing for himself. He felt that acutely ill patients were not getting the attention they needed. He pointed this out. Not once but on every occasion he could. Eventually things did change. What changed them? Was it the Grumble concern about quality? No. Not in those days anyway. Probably it was the belated realisation that, in the acute setting, employing sufficient nurses might just enable us to discharge patients more quickly. Did it work? Yes. Did Dr Grumble get any credit? No. Does he mind? No. It's much better now and that is all that matters.

But look at what happened to poor Nellie who was just trying to help out and do her best for her patients despite limited resources.